Provider Demographics
NPI:1508975657
Name:BOSTON ULTRASOUND CONSULTANTS PC
Entity Type:Organization
Organization Name:BOSTON ULTRASOUND CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-232-4600
Mailing Address - Street 1:55 POND AVE
Mailing Address - Street 2:SUITE 201E
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7170
Mailing Address - Country:US
Mailing Address - Phone:617-232-4600
Mailing Address - Fax:
Practice Address - Street 1:55 POND AVE
Practice Address - Street 2:SUITE 201E
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7170
Practice Address - Country:US
Practice Address - Phone:617-232-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM14961OtherBLUE CROSS BLUE SHIELD
MA1600064OtherUNITED HEALTHCARE
MA9760431Medicaid
MA0007192OtherNEIGHBORHOOD HEALTH
MA711720OtherTUFTS HEALTHPLAN
MA602943OtherHARVARD PILGRIM
MAM14961Medicare ID - Type Unspecified